![]() The median delay between a PCI patient’s discharge from the hospital and the time the patient first fills the antiplatelet prescription was 3 days. One study of 3 large US managed care organizations found that 16.3% of patients undergoing stent implantation delayed filling their antiplatelet prescription. Payers may have an opportunity to reduce their medical losses by designing benefits that encourage continuity of antiplatelet therapy during the period immediately following hospital discharge. However, much less information is available on the cost implications of adherence to these therapies. 3 A great deal of research has been devoted to describing costs and outcomes associated with antiplatelet therapies for stent patients. Patients requiring revascularization within a year of percutaneous coronary intervention (PCI) incur almost $25,000 more in medical expenses than those that do not. Sixty-four percent of patients with stentrelated thrombosis experience either an acute myocardial infarction (AMI) or death. 1 However, thrombosis is still an all-too-common occurrence with grave consequences for patient health. ![]() In most of the scenarios modeled here, the expected costs of these complications to insurers exceed the cost of providing copay-free discharge supplies of medication to PCI patients.ĭevelopments in antiplatelet therapy for patients undergoing cardiac stent implantation have reduced the incidence of thrombosis in patients receiving cardiac stents.Research has shown that failure to begin antiplatelet therapy promptly after PCI puts patients at increased risk for acute myocardial infarction or death, but many patients delay filling prescriptions for these medications.Managed care plans should consider waiving copayments on antiplatelet medications for percutaneous coronary intervention (PCI) patients and collaborating with hospitals to ensure that patients receive a supply of these medications upon discharge. Providing discharge supplies of antiplatelet medication resulted in lower overall costs for insurers in most of the cases modeled. However, this result is dependent on the ability of a discharge supply of medication to reduce rates of death or AMI. The strategy of offering a discharge supply of medication is cost saving under a range of estimated rehospitalization costs and medication costs. ![]() Insurers can supply up to 60 days of medication without increasing total costs. In the base case, expected costs totaled $1782 when stent implantation patients were provided with a discharge supply of medication and $1857 under the current standard of care, a difference of $75. The costs of adverse events (death or acute myocardial infarction ) are taken from Healthcare Cost and Utilization Project estimates of hospital costs for diagnosis-related groups associated with AMI. The study adopts an insurer’s perspective.ĭata on patient delays in filling antiplatelet prescriptions and rates of associated adverse events were taken from published research. To propose a model in which insurers work with hospitals to provide a discharge supply of antiplatelet medication to patients receiving stents and to examine the cost implications of this strategy.Ī decision tree was modeled using data from previously published research.
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